MEDICARE: MR. JEAN-MICHEL BALENSI CCMA, CPCP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1871929455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEAN-MICHEL BALENSI CCMA, CPCP.

Provider Business Mailing Address
First Line	:	280 LANDIS AVE
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-2627
Country	:	US
Telephone Number	:	619-476-0706
Fax Number	:

Provider Business Practice Location Address
First Line	:	280 LANDIS AVE
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-2627
Country	:	US
Telephone Number	:	619-476-0706
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	09/16/2013

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